[Congressional Record Volume 142, Number 137 (Saturday, September 28, 1996)]
[Senate]
[Pages S11732-S11742]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




        THE VETERANS' HEALTH CARE ELIGIBILITY REFORM ACT OF 1996

                                 ______
                                 

                SIMPSON (AND OTHERS) AMENDMENT NO. 5414

  Mr. NICKLES (for Mr. Simpson, for himself, Mr. Rockefeller, Mrs. 
Hutchison, Mr. Akaka, Mr. Murkowski, and Mr. Wellstone) proposed an 
amendment to the bill (H.R. 3118) to amend title 38, United States 
Code, to reform eligibility for health care provided by the Department 
of Veterans Affairs; as follows:

       Strike out all after the enacting clause and insert in lieu 
     thereof the following:

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Veterans' 
     Health Care Eligibility Reform Act of 1996''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.

                      TITLE I--ELIGIBILITY REFORM

Sec. 101. Eligibility for hospital care and medical services.
Sec. 102. Revision in authorities for provision of priority health care 
              for certain veterans exposed to specified toxic 
              substances.
Sec. 103. Prosthetics and preventive care.
Sec. 104. Management of health care.
Sec. 105. Authorization of appropriations.
Sec. 106. Assessment of implementation and operation.

                  TITLE II--CONSTRUCTION AUTHORIZATION

Sec. 201. Authorization of major medical facility projects.
Sec. 202. Authorization of major medical facility leases.
Sec. 203. Authorization of appropriations.
Sec. 204. Strategic planning.
Sec. 205. Revision to prospectus requirements.
Sec. 206. Construction authorization requirements.
Sec. 207. Terminology changes.

               TITLE III--HEALTH CARE AND ADMINISTRATION

           Subtitle A--Health Care Sharing and Administration

Sec. 301. Revision of authority to share medical facilities, equipment, 
              and information.
Sec. 302. Improved efficiency in health care resource management.
Sec. 303. Personnel furnishing shared resources.
Sec. 304. Waiting period for administrative reorganizations.
Sec. 305. Repeal of limitations on contracts for conversion of 
              performance of activities of Department health-care 
              facilities and revised annual reporting requirement.

                   Subtitle B--Care of Women Veterans

Sec. 321. Mammography quality standards.
Sec. 322. Patient privacy for women patients.
Sec. 323. Assessment of use by women veterans of Department health 
              services.
Sec. 324. Reporting requirements.

       Subtitle C--Readjustment Counseling and Mental Health Care

Sec. 331. Expansion of eligibility for readjustment counseling and 
              certain related counseling services.
Sec. 332. Reports relating to Vet Centers.
Sec. 333. Advisory Committee on the Readjustment of Veterans.
Sec. 334. Centers for mental illness research, education, and clinical 
              activities.
Sec. 335. Committee on Care of Severely Chronically Mentally Ill 
              Veterans.

                      Subtitle D--Other Provisions

Sec. 341. Hospice care study.
Sec. 342. Payment to States of per diem for veterans receiving adult 
              day health care.
Sec. 343. Research corporations.
Sec. 344. Veterans Health Administration headquarters.
Sec. 345. Disbursement agreements relating to medical residents and 
              interns.
Sec. 346. Authority to suspend special pay agreements for physicians 
              and dentists who enter residency training programs.
Sec. 347. Remunerated outside professional activities by Veterans 
              Health Administration personnel.
Sec. 348. Modification of restrictions on real property, Milwaukee 
              County, Wisconsin.
Sec. 349. Modification of restrictions on real property, Cheyenne, 
              Wyoming.
Sec. 350. Name of Department of Veterans Affairs Medical Center, 
              Johnson City, Tennessee.
Sec. 351. Report on health care needs of veterans in east central 
              Florida.
Sec. 352. Evaluation of health status of spouses and children of 
              Persian Gulf War veterans.

     SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.

       Except as otherwise expressly provided, whenever in this 
     Act an amendment or repeal is expressed in terms of an 
     amendment to or repeal of a section or other provision, the 
     reference shall be considered to be made to a section or 
     other provision of title 38, United States Code.
                      TITLE I--ELIGIBILITY REFORM

     SEC. 101. ELIGIBILITY FOR HOSPITAL CARE AND MEDICAL SERVICES.

       (a) New Criteria for Eligibility for Care.--Section 1710(a) 
     is amended to read as follows:
       ``(a)(1) The Secretary (subject to paragraph (4)) shall 
     furnish hospital care and medical services, and may furnish 
     nursing home care, which the Secretary determines to be 
     needed--
       ``(A) to any veteran for a service-connected disability; 
     and
       ``(B) to any veteran who has a service-connected disability 
     rated at 50 percent or more.
       ``(2) The Secretary (subject to paragraph (4)) shall 
     furnish hospital care and medical services, and may furnish 
     nursing home care, which the Secretary determines to be 
     needed to any veteran--
       ``(A) who has a compensable service-connected disability 
     rated less than 50 percent;
       ``(B) whose discharge or release from active military, 
     naval, or air service was for a compensable disability that 
     was incurred or aggravated in the line of duty;
       ``(C) who is in receipt of, or who, but for a suspension 
     pursuant to section 1151 of this title (or both a suspension 
     and the receipt of retired pay), would be entitled to 
     disability compensation, but only to the extent that such 
     veteran's continuing eligibility for such care is provided 
     for in the judgment or settlement provided for in such 
     section;
       ``(D) who is a former prisoner of war;
       ``(E) who is a veteran of the Mexican border period or of 
     World War I;
       ``(F) who was exposed to a toxic substance, radiation, or 
     environmental hazard, as provided in subsection (e); or
       ``(G) who is unable to defray the expenses of necessary 
     care as determined under section 1722(a) of this title.
       ``(3) In the case of a veteran who is not described in 
     paragraphs (1) and (2), the Secretary may, to the extent 
     resources and facilities are available and subject to the 
     provisions of subsections (f) and (g), furnish hospital care, 
     medical services, and nursing

[[Page S11733]]

     home care which the Secretary determines to be needed.
       ``(4) The requirement in paragraphs (1) and (2) that the 
     Secretary furnish hospital care and medical services shall be 
     effective in any fiscal year only to the extent and in the 
     amount provided in advance in appropriations Acts for such 
     purposes.''.
       (b) Transfer of Provision.--Chapter 17 is amended--
       (1) by redesignating subsection (g) of section 1710 as 
     subsection (h); and
       (2) by transferring subsection (f) of section 1712 to 
     section 1710 and inserting such subsection so as to appear 
     after subsection (f), redesignating such subsection as 
     subsection (g), and amending such subsection by striking out 
     ``section 1710(a)(2) of this title'' in paragraph (1) and 
     inserting in lieu thereof ``subsection (a)(3) of this 
     section''.
       (c) Repeal of Separate Outpatient Care Priorities.--(1) 
     Section 1712 is amended--
       (A) by striking out subsections (a) and (i);
       (B) by redesignating subsections (b), (c), (d), (h) and 
     (j), as subsections (a), (b), (c), (d), and (e), 
     respectively; and
       (C) in subsection (b), as so redesignated, by striking out 
     ``subsection (b) of this section'' and inserting in lieu 
     thereof ``subsection (a)''.
       (2)(A) The heading of such section is amended to read as 
     follows:

     ``Sec. 1712. Dental care; drugs and medicines for certain 
       disabled veterans; vaccines''.

       (B) The item relating to such section in the table of 
     sections at the beginning of chapter 17 is amended to read as 
     follows:

``1712. Dental care; drugs and medicines for certain disabled veterans; 
              vaccines.''.

       (d) Conforming Amendments to Chapter 17.--Chapter 17 is 
     further amended as follows:
       (1) Section 1701(6)(B)(i) is amended--
       (A) in subclause (I), by striking out ``section 1712(a)'' 
     and inserting in lieu thereof ``paragraph (1) or (2) of 
     section 1710(a)''; and
       (B) in subclause (II), by striking out ``section 
     1712(a)(5)(B)'' and inserting in lieu thereof ``paragraph 
     (1), (2) or (3) of section 1710(a)''.
       (2) Section 1710(c)(1) is amended by striking out ``section 
     1712(b)'' and inserting in lieu thereof ``section 1712(a)''.
       (3) Section 1710(e)(1)(C) is amended by striking out 
     ``hospital care and nursing home care under subsection 
     (a)(1)(G) of this section'' and inserting in lieu thereof 
     ``hospital care, medical services, and nursing home care 
     under subsection (a)(2)(F)''.
       (4) Section 1710(f) is amended--
       (A) in paragraph (1), by striking out ``subsection (a)(2)'' 
     and inserting in lieu thereof ``subsection (a)(3)''; and
       (B) in paragraph (3)(E)--
       (i) by striking out ``section 1712(a) of this title'' and 
     inserting in lieu thereof ``paragraph (3) of subsection 
     (a)''; and
       (ii) by striking out ``section 1712(f) of this title'' and 
     inserting in lieu thereof ``subsection (g)''; and
       (C) in paragraph (3)(F), by striking out ``section 1712(f) 
     of this title'' and inserting in lieu thereof ``subsection 
     (g)''.
       (5) Section 1712A is amended--
       (A) in subsection (b)(1), by striking out ``under the 
     conditions specified in section 1712(a)(5)(B) of this 
     title''; and
       (B) in subsection (e)(1), by striking out ``sections 
     1712(a)(1)(B) and 1703(a)(2)'' and inserting in lieu thereof 
     ``sections 1703(a)(2) and 1710(a)(1)(B)''.
       (6) Section 1717(a) is amended--
       (A) in paragraph (1), by striking out ``section 1712(a)'' 
     and inserting in lieu thereof ``section 1710(a)''; and
       (B) in paragraph (2)--
       (i) in subparagraph (A), by striking out ``paragraph (1) of 
     section 1712(a) of this title'' and inserting in lieu thereof 
     ``section 1710(a)(1) of this title, or for a disability 
     described in section 1710(a)(2)(C) of this title''; and
       (ii) in subparagraph (B), by striking out ``section 1712'' 
     and inserting in lieu thereof ``section 1710(a)(2)''.
       (7) Section 1718(e) is amended by striking out ``section 
     1712(i)'' and inserting in lieu thereof ``section 1705''.
       (8) Section 1720(f) is amended--
       (A) in paragraph (1)(A)(ii), by striking out ``section 
     1712(a)(1)(B)'' and inserting in lieu thereof ``paragraph 
     (1), (2), or (3) of section 1710(a)''; and
       (B) by striking out paragraph (3).
       (9) Section 1722 is amended--
       (A) in subsection (a), by striking out ``section 
     1710(a)(1)(I)'' and inserting in lieu thereof ``section 
     1710(a)(2)(G)''; and
       (B) in subsection (f)(3), by striking out ``or 1712(f)''.
       (10) Section 1729(g)(3)(A) is amended by striking out 
     ``under section 1710(f) of this title for hospital care or 
     nursing home care, under section 1712(f) of this title for 
     medical services,'' and inserting in lieu thereof ``under 
     subsection (f) or (g) of section 1710 of this title for 
     hospital care, medical services, or nursing home care''.
       (e) Other Conforming and Technical Amendments.--
       (1) Section 1525 is amended--
       (A) in subsection (a), by striking out ``section 1712(h) of 
     this title'' and all that follows through the period at the 
     end and inserting in lieu thereof ``section 1712(d) of this 
     title.''; and
       (B) in subsection (b), by striking out ``renumeration'' and 
     inserting in lieu thereof ``remuneration''.
       (2) Section 2104(b) is amended--
       (A) in the first sentence, by striking out ``section 
     1712(a)'' and inserting in lieu thereof ``section 
     1717(a)(2)''; and
       (B) in the second sentence, by striking out ``section 
     1712(a)'' and inserting in lieu thereof ``section 
     1717(a)(2)''.
       (3) Section 5317(c)(3) is amended by striking out 
     ``sections 1710(a)(1)(I), 1710(a)(2), 1710(b), and 
     1712(a)(2)(B)'' and inserting in lieu thereof ``subsections 
     (a)(2)(G), (a)(3), and (b) of section 1710''.
       (4) Section 8110(a)(2) is amended by striking out ``section 
     1712'' and inserting in lieu thereof ``section 1710(a)''.
       (5) Section 8111A(b)(2)(A) is amended by striking out 
     ``subsection (f) of section 1712'' and inserting in lieu 
     thereof ``subsection (a) of section 1710''.

     SEC. 102. REVISION IN AUTHORITIES FOR PROVISION OF PRIORITY 
                   HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO 
                   SPECIFIED TOXIC SUBSTANCES.

       (a) Authorized Inpatient Care.--Section 1710(e) is 
     amended--
       (1) in paragraph (1), by striking out subparagraphs (A) and 
     (B) and inserting in lieu thereof the following:
       ``(A) A Vietnam-era herbicide-exposed veteran is eligible 
     (subject to paragraph (2)) for hospital care, medical 
     services, and nursing home care under subsection (a)(2)(F) 
     for any disability, notwithstanding that there is 
     insufficient medical evidence to conclude that such 
     disability may be associated with such exposure.
       ``(B) A radiation-exposed veteran is eligible for hospital 
     care, medical services, and nursing home care under 
     subsection (a)(2)(F) for any disease suffered by the veteran 
     that is--
       ``(i) a disease listed in section 1112(c)(2) of this title; 
     or
       ``(ii) any other disease for which the Secretary, based on 
     the advice of the Advisory Committee on Environmental 
     Hazards, determines that there is credible evidence of a 
     positive association between occurrence of the disease in 
     humans and exposure to ionizing radiation.''; and
       (2) by striking out paragraphs (2) and (3) and inserting in 
     lieu thereof the following:
       ``(2)(A) In the case of a veteran described in paragraph 
     (1)(A), hospital care, medical services, and nursing home 
     care may not be provided under subsection (a)(2)(F) with 
     respect to--
       ``(i) a disability that is found, in accordance with 
     guidelines issued by the Under Secretary for Health, to have 
     resulted from a cause other than an exposure described in 
     paragraph (4)(A)(ii); or
       ``(ii) a disease for which the National Academy of 
     Sciences, in a report issued in accordance with section 2 of 
     the Agent Orange Act of 1991, has determined that there is 
     limited or suggestive evidence of the lack of a positive 
     association between occurrence of the disease in humans and 
     exposure to a herbicide agent.
       ``(B) In the case of a veteran described in paragraph 
     (1)(C), hospital care, medical services, and nursing home 
     care may not be provided under subsection (a)(2)(F) with 
     respect to a disability that is found, in accordance with 
     guidelines issued by the Under Secretary for Health, to have 
     resulted from a cause other than an exposure described in 
     that paragraph.
       ``(3) Hospital care, medical services, and nursing home 
     care may not be provided under or by virtue of subsection 
     (a)(2)(F)--
       ``(A) in the case of care for a veteran described in 
     paragraph (1)(A), after December 31, 2002; and
       ``(B) in the case of care for a veteran described in 
     paragraph (1)(C), after December 31, 1998.
       ``(4) For purposes of this subsection--
       ``(A) The term `Vietnam-era herbicide-exposed veteran' 
     means a veteran (i) who served on active duty in the Republic 
     of Vietnam during the Vietnam era, and (ii) who the Secretary 
     finds may have been exposed during such service to dioxin or 
     was exposed during such service to a toxic substance found in 
     a herbicide or defoliant used for military purposes during 
     such era.
       ``(B) The term `radiation-exposed veteran' has the meaning 
     given that term in section 1112(c)(3) of this title.''.
       (b) Savings Provisions.--The provisions of sections 1710(e) 
     and 1712(a) of title 38, United States Code, as in effect on 
     the day before the date of the enactment of this Act, shall 
     continue to apply on and after such date with respect to the 
     furnishing of hospital care, nursing home care, and medical 
     services for any veteran who was furnished such care or 
     services before such date of enactment on the basis of 
     presumed exposure to a substance or radiation under the 
     authority of those provisions, but only for treatment for a 
     disability for which such care or services were furnished 
     before such date.

     SEC. 103. PROSTHETICS AND PREVENTIVE CARE.

       (a) Eligibility.--Section 1701(6)(A)(i) is amended--
       (1) by striking out ``(in the case of a person otherwise 
     receiving care or services under this chapter)'' and 
     ``(except under the conditions described in section 
     1712(a)(5)(A) of this title),'';
       (2) by inserting ``(in the case of a person otherwise 
     receiving care or services under this chapter)'' before 
     ``wheelchairs,''; and
       (3) by inserting ``except that the Secretary may not 
     furnish sensori-neural aids other than in accordance with 
     guidelines which the Secretary shall prescribe,'' after 
     ``reasonable and necessary,''.
       (b) Regulations.--Not later than 30 days after the date of 
     the enactment of this Act,

[[Page S11734]]

     the Secretary of Veterans Affairs shall prescribe the 
     guidelines required by the amendments made by subsection (a) 
     and shall furnish a copy of those guidelines to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives.

     SEC. 104. MANAGEMENT OF HEALTH CARE.

       (a) In General.--(1) Chapter 17 is amended by inserting 
     after section 1704 the following new sections:

     ``Sec. 1705. Management of health care: patient enrollment 
       system

       ``(a) In managing the provision of hospital care and 
     medical services under section 1710(a) of this title, the 
     Secretary, in accordance with regulations the Secretary shall 
     prescribe, shall establish and operate a system of annual 
     patient enrollment. The Secretary shall manage the enrollment 
     of veterans in accordance with the following priorities, in 
     the order listed:
       ``(1) Veterans with service-connected disabilities rated 50 
     percent or greater.
       ``(2) Veterans with service-connected disabilities rated 30 
     percent or 40 percent.
       ``(3) Veterans who are former prisoners of war, veterans 
     with service-connected disabilities rated 10 percent or 20 
     percent, and veterans described in subparagraphs (B) and (C) 
     of section 1710(a)(2) of this title.
       ``(4) Veterans who are in receipt of increased pension 
     based on a need of regular aid and attendance or by reason of 
     being permanently housebound and other veterans who are 
     catastrophically disabled.
       ``(5) Veterans not covered by paragraphs (1) through (4) 
     who are unable to defray the expenses of necessary care as 
     determined under section 1722(a) of this title.
       ``(6) All other veterans eligible for hospital care, 
     medical services, and nursing home care under section 
     1710(a)(2) of this title.
       (7) Veterans described in section 1710(a)(3) of this title.
       ``(b) In the design of an enrollment system under 
     subsection (a), the Secretary--
       ``(1) shall ensure that the system will be managed in a 
     manner to ensure that the provision of care to enrollees is 
     timely and acceptable in quality;
       ``(2) may establish additional priorities within each 
     priority group specified in subsection (a), as the Secretary 
     determines necessary; and
       ``(3) may provide for exceptions to the specified 
     priorities where dictated by compelling medical reasons.
       ``(c)(1) Effective on October 1, 1998, the Secretary may 
     not provide hospital care or medical services to a veteran 
     under paragraph (2) or (3) of section 1710(a) of this title 
     unless the veteran enrolls in the system of patient 
     enrollment established by the Secretary under subsection (a).
       ``(2) The Secretary shall provide hospital care and medical 
     services under section 1710(a)(1) of this title, and under 
     subparagraph (B) of section 1710(a)(2) of this title, for the 
     12-month period following such veteran's discharge or release 
     from service, to any veteran referred to in such sections for 
     a disability specified in the applicable subparagraph of such 
     section, notwithstanding the failure of the veteran to enroll 
     in the system of patient enrollment referred to in subsection 
     (a) of this section.

     ``Sec. 1706. Management of health care: other requirements

       ``(a) In managing the provision of hospital care and 
     medical services under section 1710(a) of this title, the 
     Secretary shall, to the extent feasible, design, establish 
     and manage health care programs in such a manner as to 
     promote cost-effective delivery of health care services in 
     the most clinically appropriate setting.
       ``(b)(1) In managing the provision of hospital care and 
     medical services under such section, the Secretary shall 
     ensure that the Department maintains its capacity to provide 
     for the specialized treatment and rehabilitative needs of 
     disabled veterans (including veterans with spinal cord 
     dysfunction, blindness, amputations, and mental illness) 
     within distinct programs or facilities of the Department that 
     are dedicated to the specialized needs of those veterans in a 
     manner that (A) affords those veterans reasonable access to 
     care and services for those specialized needs, and (B) 
     ensures that overall capacity of the Department to provide 
     such services is not reduced below the capacity of the 
     Department, nationwide, to provide those services, as of the 
     date of the enactment of this section. The Secretary shall 
     carry out this paragraph in consultation with the Advisory 
     Committee on Prosthetics and Special Disabilities Programs 
     and the Committee on Care of Severely Chronically Mentally 
     Ill Veterans.
       ``(2) Not later than April 1, 1997, April 1, 1998, and 
     April 1, 1999, the Secretary shall submit to the Committees 
     on Veterans' Affairs of the Senate and House of 
     Representatives a report on the Secretary's compliance, by 
     facility and by service-network, with the requirements of 
     this subsection.''.
       (2) The table of sections at the beginning of chapter 17 is 
     amended by inserting after the item relating to section 1704 
     the following new items:

``1705. Management of health care: patient enrollment system.
``1706. Management of health care: other requirements.''.

       (b) Conforming Amendments to Section 1703.--Section 1703(a) 
     is amended--
       (1) in the matter preceding paragraph (1), by striking out 
     ``or 1712'';
       (2) in paragraph (2)--
       (A) by striking out ``1712(a)(1)(B)'' in subparagraph (A) 
     and inserting in lieu thereof ``1710(a)(1)(B)'';
       (B) by striking out subparagraph (B) and inserting in lieu 
     thereof the following:
       ``(B) a veteran who (i) has been furnished hospital care, 
     nursing home care, domiciliary care, or medical services, and 
     (ii) requires medical services to complete treatment incident 
     to such care or services; or''; and
       (C) by striking ``section 1712(a)(3) (other than a veteran 
     who is a former prisoner of war) of this title'' in 
     subparagraph (C) and inserting in lieu thereof ``section 
     1710(a)(2)(E) of this title, or a veteran who is in receipt 
     of increased pension, or additional compensation or 
     allowances based on the need of regular aid and attendance or 
     by reason of being permanently housebound (or who, but for 
     the receipt of retired pay, would be in receipt of such 
     pension, compensation, or allowance),''; and
       (3) in paragraph (7), by striking out ``1712(b)(1)(F)'' and 
     inserting in lieu thereof ``1712(a)(1)(F)''.

     SEC. 105. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated for the Department 
     of Veterans Affairs for the Medical Care account, for the 
     purposes specified for that account in Public Law 103-327 
     (108 Stat. 2300), including the cost of providing hospital 
     care and medical services under the amendments made by 
     section this title, not to exceed $17,250,000,000 for fiscal 
     year 1997 and not to exceed $17,900,000,000 for fiscal year 
     1998.

     SEC. 106. ASSESSMENT OF IMPLEMENTATION AND OPERATION.

       (a) Assessment Systems.--The Secretary of Veterans Affairs 
     shall establish information systems to assess the experience 
     of the Department of Veterans Affairs in implementing 
     sections 101, 103, and 104, including the amendments made by 
     those sections, during fiscal year 1997. The Secretary shall 
     establish those information systems in time to include 
     assessments under such systems in the report required under 
     subsection (b).
       (b) Report.--Not later than March 1, 1998, the Secretary 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report reflecting the 
     experience of the Department during fiscal year 1997 on--
       (1) the effect of implementation of, and provision and 
     management of care under, sections 101, 103, and 104 
     (including the amendments made by those sections) on demand 
     for health care services from the Department of Veterans 
     Affairs by veterans described in paragraphs (1), (2), and (3) 
     of section 1710(a) of title 38, United States Code, as 
     amended by section 101;
       (2) any differing patterns of demand on the part of such 
     veterans relating to such factors as relative distance from 
     Department facilities and prior experience, or lack of 
     experience, as recipients of care from the Department;
       (3) the extent to which the Department has met such demand 
     for care; and
       (4) changes in health-care delivery patterns in Department 
     facilities and the fiscal impact of such changes.
       (c) Matters To Be Included.--The report under subsection 
     (b) shall include detailed information with respect to fiscal 
     year 1997 regarding the following:
       (1) The number of veterans enrolled for care at each 
     Department medical facility and, of such veterans, the number 
     enrolled at each such facility who had not received care from 
     the Department during the preceding three fiscal years.
       (2) With respect to the veterans who had not received care 
     from the Department during the three preceding fiscal years, 
     the total cost of providing care to such veterans, shown in 
     total and separately (A) by level of care, and (B) by 
     reference to whether care was furnished in Department 
     facilities or under contract arrangements.
       (3) With respect to the number of veterans described in 
     paragraphs (1), (2), and (3) of section 1710(a) of title 38, 
     United States Code, as amended by section 101, who applied 
     for health care from the Department during fiscal year 1997--
       (A) the number who applied for care (shown in total and 
     separately by facility);
       (B) the number who were denied enrollment (shown in total 
     and separately by facility); and
       (C) the number who were denied care which was considered to 
     be medically necessary but not of an emergency nature (shown 
     in total and separately by facility).
       (4) The numbers and characteristics of, and the type and 
     extent of health care furnished to, veterans enrolled for 
     care (shown in total and separately by facility).
       (5) The numbers and characteristics of, and the type and 
     extent of health care furnished to, veterans not enrolled for 
     care (shown separately by reference to each class of 
     eligibility, both in total and separately by facility).
       (6) The specific fiscal impact (shown in total and by 
     geographic health-care delivery areas) of changes in delivery 
     patterns instituted under the amendments made by this title.
                  TITLE II--CONSTRUCTION AUTHORIZATION

     SEC. 201. AUTHORIZATION OF MAJOR MEDICAL FACILITY PROJECTS.

       (a) Ambulatory Care Addition Projects.--The Secretary of 
     Veterans Affairs may carry out the following ambulatory care 
     addition major medical facility

[[Page S11735]]

     projects, with each project to be carried out in the amount 
     specified for that project:
       (1) Construction of an ambulatory care facility and 
     renovation of ``E'' wing, Tripler Army Hospital, Honolulu, 
     Hawaii, $43,000,000.
       (2) Addition of ambulatory care facilities at the 
     Department of Veterans Affairs medical center in Brockton, 
     Massachusetts, $13,500,000.
       (3) Addition of ambulatory care facilities for outpatient 
     improvements at the Department of Veterans Affairs medical 
     center in Shreveport, Louisiana, $25,000,000.
       (4) Addition of ambulatory care facilities at the 
     Department of Veterans Affairs medical center in Lyons, New 
     Jersey, $21,100,000.
       (5) Addition of ambulatory care facilities at the 
     Department of Veterans Affairs medical center in Tomah, 
     Wisconsin, $12,700,000.
       (6) Addition of ambulatory care facilities at the 
     Department of Veterans Affairs medical center in Asheville, 
     North Carolina, $26,300,000.
       (7) Addition of ambulatory care facilities at the 
     Department of Veterans Affairs medical center in Temple, 
     Texas, $9,800,000.
       (8) Addition of ambulatory care facilities at the 
     Department of Veterans Affairs medical center in Tucson, 
     Arizona, $35,500,000.
       (9) Construction of an ambulatory care facility at the 
     Department of Veterans Affairs medical center in Leavenworth, 
     Kansas, $27,750,000.
       (b) Environmental Improvement Projects.--The Secretary may 
     carry out the following environmental improvement major 
     medical facility projects, with each project to be carried 
     out in the amount specified for that project:
       (1) Environmental improvements for the renovation of 
     nursing home facilities at the Department of Veterans Affairs 
     medical center in Lebanon, Pennsylvania, $9,500,000.
       (2) Environmental improvements at the Department of 
     Veterans Affairs medical center in Marion, Illinois, 
     $11,500,000.
       (3) Environmental improvements for ward renovation for 
     patient privacy at the Department of Veterans Affairs medical 
     center in Omaha, Nebraska, $7,700,000.
       (4) Environmental improvements at the Department of 
     Veterans Affairs medical center in Pittsburgh, Pennsylvania, 
     $17,400,000.
       (5) Environmental improvements for the renovation of 
     various buildings at the Department of Veterans Affairs 
     medical center in Waco, Texas, $26,000,000.
       (6) Environmental improvements for the replacement of 
     psychiatric beds at the Department of Veterans Affairs 
     medical center in Marion, Indiana, $17,300,000.
       (7) Environmental improvements for the renovation of 
     psychiatric wards at the Department of Veterans Affairs 
     medical center in Perry Point, Maryland, $15,100,000.
       (8) Environmental enhancement at the Department of Veterans 
     Affairs medical center in Salisbury, North Carolina, 
     $18,200,000.
       (c) Seismic Correction Project.--The Secretary may carry 
     out seismic corrections to Building Number 324 at the 
     Department of Veterans Affairs medical center in Palo Alto, 
     California, in the amount of $20,800,000.
       (d) Project Authorization When Partial Funding Provided.--
     If the amount of funds appropriated for fiscal year 1997 or 
     1998 for design and partial construction of a major medical 
     facility project that is authorized in this section is less 
     than the amount required to complete the construction of that 
     project as authorized and if the Secretary obligates funds 
     for such construction, such project shall be deemed to be 
     fully authorized. Any such authorization shall cease to have 
     effect at the close of fiscal year 2001.

     SEC. 202. AUTHORIZATION OF MAJOR MEDICAL FACILITY LEASES.

       The Secretary of Veterans Affairs may enter into leases for 
     medical facilities as follows:
       (1) Lease of a satellite outpatient clinic in Allentown, 
     Pennsylvania, in an amount not to exceed $2,159,000.
       (2) Lease of a satellite outpatient clinic in Beaumont, 
     Texas, in an amount not to exceed $1,940,000.
       (3) Lease of a satellite outpatient clinic in Boston, 
     Massachusetts, in an amount not to exceed $2,358,000.
       (4) Lease of a parking facility in Cleveland, Ohio, in an 
     amount not to exceed $1,300,000.
       (5) Lease of a satellite outpatient clinic and Veterans 
     Benefits Administration field office in San Antonio, Texas, 
     in an amount not to exceed $2,256,000.
       (6) Lease of a satellite outpatient clinic in Toledo, Ohio, 
     in an amount not to exceed $2,223,000.

     SEC. 203. AUTHORIZATION OF APPROPRIATIONS.

       (a) In General.--There are authorized to be appropriated to 
     the Secretary of Veterans Affairs for fiscal year 1997 and 
     fiscal year 1998--
       (1) for the Construction, Major Projects, account, a total 
     of $358,150,000 for the projects authorized in section 201; 
     and
       (2) for the Medical Care account, a total of $12,236,000 
     for the leases authorized in section 202.
       (b) Limitation.--The projects authorized in section 201 may 
     only be carried out using--
       (1) funds appropriated for fiscal year 1997 or fiscal year 
     1998 consistent with the authorization of appropriations in 
     subsection (a);
       (2) funds appropriated for Construction, Major Projects for 
     a fiscal year before fiscal year 1997 that remain available 
     for obligation; and
       (3) funds appropriated for Construction, Major Projects for 
     fiscal year 1997 or fiscal year 1998 for a category of 
     activity not specific to a project.

     SEC. 204. STRATEGIC PLANNING.

       Section 8107 is amended--
       (1) by redesignating subsection (b) as subsection (c);
       (2) by striking out subsection (a) and inserting in lieu 
     thereof the following new subsections:
       ``(a) In order to promote effective planning for the 
     efficient provision of care to eligible veterans, the 
     Secretary, based on the analysis and recommendations of the 
     Under Secretary for Health, shall submit to each committee an 
     annual report regarding long-range health planning of the 
     Department. The report shall be submitted each year not later 
     than the date on which the budget for the next fiscal year is 
     submitted to the Congress under section 1105 of title 31.
       ``(b) Each report under subsection (a) shall include the 
     following:
       ``(1) A five-year strategic plan for the provision of care 
     under chapter 17 of this title to eligible veterans through 
     coordinated networks of medical facilities operating within 
     prescribed geographic service-delivery areas, such plan to 
     include provision of services for the specialized treatment 
     and rehabilitative needs of disabled veterans (including 
     veterans with spinal cord dysfunction, blindness, 
     amputations, and mental illness) through distinct programs or 
     facilities of the Department dedicated to the specialized 
     needs of those veterans.
       ``(2) A description of how planning for the networks will 
     be coordinated.
       ``(3) A profile regarding each such network of medical 
     facilities which identifies--
       ``(A) the mission of each existing or proposed medical 
     facility in the network;
       ``(B) any planned change in the mission for any such 
     facility and the rationale for such planned change;
       ``(C) the population of veterans to be served by the 
     network and anticipated changes over a five-year period and a 
     ten-year period, respectively, in that population and in the 
     health-care needs of that population;
       ``(D) information relevant to assessing progress toward the 
     goal of achieving relative equivalency in the level of 
     resources per patient distributed to each network, such 
     information to include the plans for and progress toward 
     lowering the cost of care-delivery in the network (by means 
     such as changes in the mix in the network of physicians, 
     nurses, physician assistants, and advance practice nurses);
       ``(E) the capacity of non-Federal facilities in the network 
     to provide acute, long-term, and specialized treatment and 
     rehabilitative services (described in section 7305 of this 
     title), and determinations regarding the extent to which 
     services to be provided in each service-delivery area and 
     each facility in such area should be provided directly 
     through facilities of the Department or through contract or 
     other arrangements, including arrangements authorized under 
     sections 8111 and 8153 of this title; and
       ``(F) a five-year plan for construction, replacement, or 
     alteration projects in support of the approved mission of 
     each facility in the network and a description of how those 
     projects will improve access to care, or quality of care, for 
     patients served in the network.
       ``(4) A status report for each facility on progress 
     toward--
       ``(A) instituting planned mission changes identified under 
     paragraph (3)(B);
       ``(B) implementing principles of managed care of eligible 
     veterans; and
       ``(C) developing and instituting cost-effective 
     alternatives to provision of institutional care.''; and
       (3) by adding at the end the following new subsection:
       ``(d)(1) The Secretary shall submit to each committee, not 
     later than January 31 of each year, a report showing the 
     current priorities of the Department for proposed major 
     medical construction projects. Each such report shall 
     identify the 20 projects, from within all the projects in the 
     Department's inventory of proposed projects, that have the 
     highest priority and, for those 20 projects, the relative 
     priority and rank scoring of each such project and the 
     projected cost of such project (including the projected 
     operating costs, including both recurring and nonrecurring 
     costs). The 20 projects shall be compiled, and their relative 
     rankings shall be shown, by category of project (including 
     the categories of ambulatory care projects, nursing home care 
     projects, and such other categories as the Secretary 
     determines).
       ``(2) The Secretary shall include in each report, for each 
     project listed, a description of the specific factors that 
     account for the relative ranking of that project in relation 
     to other projects within the same category.
       ``(3) In a case in which the relative ranking of a proposed 
     project has changed since the last report under this 
     subsection was submitted, the Secretary shall also include in 
     the report a description of the reasons for the change in the 
     ranking, including an explanation of any change in the 
     scoring of the project under the Department's scoring system 
     for proposed major medical construction projects.''.

     SEC. 205. REVISION TO PROSPECTUS REQUIREMENTS.

       (a) Additional Information.--Section 8104(b) is amended--

[[Page S11736]]

       (1) by striking out the matter preceding paragraph (1) and 
     inserting in lieu thereof the following:
       ``(b) Whenever the President or the Secretary submit to the 
     Congress a request for the funding of a major medical 
     facility project (as defined in subsection (a)(3)(A)) or a 
     major medical facility lease (as defined in subsection 
     (a)(3)(B)), the Secretary shall submit to each committee, on 
     the same day, a prospectus of the proposed medical facility. 
     Any such prospectus shall include the following:'';
       (2) in paragraph (1)--
       (A) by striking out ``a detailed'' and inserting in lieu 
     thereof ``A detailed''; and
       (B) by striking out the semicolon at the end and inserting 
     in lieu thereof a period;
       (3) in paragraph (2)--
       (A) by striking out ``an estimate'' and inserting in lieu 
     thereof ``An estimate''; and
       (B) by striking out ``; and'' and inserting in lieu thereof 
     a period;
       (4) in paragraph (3), by striking out ``an estimate'' and 
     inserting in lieu thereof ``An estimate''; and
       (5) by adding at the end the following new paragraphs:
       ``(4) Demographic data applicable to such facility, 
     including information on projected changes in the population 
     of veterans to be served by the facility over a five-year 
     period and a ten-year period.
       ``(5) Current and projected workload and utilization data 
     regarding the facility.
       ``(6) Current and projected operating costs of the 
     facility, including both recurring and non-recurring costs.
       ``(7) The priority score assigned to the project or lease 
     under the Department's prioritization methodology and, if the 
     project or lease is being proposed for funding before a 
     project or lease with a higher score, a specific explanation 
     of the factors other than the priority score that were 
     considered and the basis on which the project or lease is 
     proposed for funding ahead of projects or leases with higher 
     priority scores.
       ``(8) In the case of a prospectus proposing the 
     construction of a new or replacement medical facility, a 
     description of each alternative to construction of the 
     facility that was considered.''.
       (b) Applicability.--The amendments made by subsection (a) 
     shall apply with respect to any prospectus submitted by the 
     Secretary of Veterans Affairs after the date of the enactment 
     of this Act.

     SEC. 206. CONSTRUCTION AUTHORIZATION REQUIREMENTS.

       (a) Definition of Major Medical Facility Project.--
     Paragraph (3)(A) of section 8104(a) is amended by striking 
     out ``$3,000,000'' and inserting in lieu thereof 
     ``$4,000,000''.
       (b) Applicability of Construction Authorization 
     Requirement.--(1) Subsection (b) of section 301 of the 
     Veterans' Medical Programs Amendments of 1992 (Public Law 
     102-405; 106 Stat. 1984) is repealed.
       (2) The amendments made by subsection (a) of such section 
     shall apply with respect to any major medical facility 
     project or any major medical facility lease of the Department 
     of Veterans Affairs, regardless of when funds are first 
     appropriated for that project or lease, except that in the 
     case of a project for which funds were first appropriated 
     before October 9, 1992, such amendments shall not apply with 
     respect to amounts appropriated for that project for a fiscal 
     year before fiscal year 1998.
       (c) Limitation on Obligations for Advance Planning.--
     Section 8104 is amended by adding at the end the following 
     new subsection:
       ``(f) The Secretary may not obligate funds in an amount in 
     excess of $500,000 from the Advance Planning Fund of the 
     Department toward design or development of a major medical 
     facility project (as defined in subsection (a)(3)(A)) until--
       ``(1) the Secretary submits to the committees a report on 
     the proposed obligation; and
       ``(2) a period of 30 days has passed after the date on 
     which the report is received by the committees.''.

     SEC. 207. TERMINOLOGY CHANGES.

       (a) Definition of ``Construct''.--Section 8101(2) is 
     amended--
       (1) by striking out ``working drawings'' and inserting in 
     lieu thereof ``construction documents''; and
       (2) by striking out ``preliminary plans'' and inserting in 
     lieu thereof ``design development''.
       (b) Parking Facilities.--Section 8109(h)(3)(B) is amended 
     by striking out ``working drawings'' and inserting in lieu 
     thereof ``construction documents''.
               TITLE III--HEALTH CARE AND ADMINISTRATION
           Subtitle A--Health Care Sharing and Administration

     SEC. 301. REVISION OF AUTHORITY TO SHARE MEDICAL FACILITIES, 
                   EQUIPMENT, AND INFORMATION.

       (a) Statement of Purpose.--The text of section 8151 is 
     amended to read as follows:
       ``It is the purpose of this subchapter to strengthen the 
     medical programs at Department facilities and improve the 
     quality of health care provided veterans under this title by 
     authorizing the Secretary to enter into agreements with 
     health-care providers in order to share health-care resources 
     with, and receive health-care resources from, such providers 
     while ensuring no diminution of services to veterans.''.
       (b) Definitions.--Section 8152 is amended--
       (1) by striking out paragraphs (1), (2), and (3) and 
     inserting in lieu thereof the following new paragraphs (1) 
     and (2):
       ``(1) The term `health-care resource' includes hospital 
     care and medical services (as those terms are defined in 
     section 1701 of this title), any other health-care service, 
     and any health-care support or administrative resource.
       ``(2) The term `health-care providers' includes health-care 
     plans and insurers and any organizations, institutions, or 
     other entities or individuals who furnish health-care 
     resources.''; and
       (2) by redesignating paragraph (4) as paragraph (3).
       (c) Authority To Secure Health-Care Resources.--Section 
     8153 is amended as follows:
       (1) Subsection (a) is amended--
       (A) in paragraph (1)--
       (i) by striking out ``certain specialized medical 
     resources'' and inserting in lieu thereof ``health-care 
     resources'';
       (ii) by striking out ``other medical resources'' and 
     inserting in lieu thereof ``other health-care resources''; 
     and
       (iii) by striking out ``of--'' and all that follows through 
     ``section 1742(a) of this title'' and inserting in lieu 
     thereof ``of health-care resources between Department health-
     care facilities and any health-care provider, or other entity 
     or individual'';
       (B) in paragraph (2), by striking out ``only'' and all that 
     follows through ``are not'' and inserting in lieu thereof 
     ``if such resources are not, or would not be,''; and
       (C) by adding at the end the following:
       ``(3)(A) If the health-care resource required is a 
     commercial service, the use of medical equipment or space, or 
     research, and is to be acquired from an institution 
     affiliated with the Department in accordance with section 
     7302 of this title, including medical practice groups and 
     other entities associated with affiliated institutions, blood 
     banks, organ banks, or research centers, the Secretary may 
     make arrangements for acquisition of the resource without 
     regard to any law or regulation that would otherwise require 
     the use of competitive procedures for acquiring the resource.
       ``(B)(i) If the health-care resource required is a 
     commercial service or the use of medical equipment or space, 
     and is not to be acquired from an entity described in 
     subparagraph (A), any procurement of the resource may be 
     conducted without regard to any law or regulation that would 
     otherwise require the use of competitive procedures for 
     procuring the resource, but only if the procurement is 
     conducted in accordance with the simplified procedures 
     prescribed pursuant to clause (ii).
       ``(ii) The Secretary, in consultation with the 
     Administrator for Federal Procurement Policy, may prescribe 
     simplified procedures for the procurement of health-care 
     resources under this subparagraph. The Secretary shall 
     publish such procedures for public comment in accordance with 
     section 22 of the Office of Federal Procurement Policy Act 
     (41 U.S.C. 418b). Such procedures shall permit all 
     responsible sources to submit a bid, proposal, or quotation 
     (as appropriate) for the resources to be procured and provide 
     for the consideration by the Department of bids, proposals, 
     or quotations so submitted.
       ``(iii) Pending publication of the procedures under clause 
     (ii), the Secretary shall (except as provided under 
     subparagraph (A)) procure health-care resources referred to 
     in clause (i) in accordance with all procurement laws and 
     regulations.
       ``(C) Any procurement of health-care resources other than 
     those covered by subparagraph (A) or (B) shall be conducted 
     in accordance with all procurement laws and regulations.
       ``(D) For any procurement to be conducted on a sole source 
     basis other than a procurement covered by subparagraph (A), a 
     written justification shall be prepared that includes the 
     information and is approved at the levels prescribed in 
     section 303(f) of the Federal Property and Administrative 
     Services Act of 1949 (41 U.S.C. 253(f)).
       ``(E) As used in this paragraph, the term `commercial 
     service' means a service that is offered and sold 
     competitively in the commercial marketplace, is performed 
     under standard commercial terms and conditions, and is 
     procured using firm-fixed price contracts.''.
       (2) Subsection (b) is amended by striking out ``reciprocal 
     reimbursement'' in the first sentence and all that follows 
     through the period at the end of that sentence and inserting 
     in lieu thereof ``payment to the Department in accordance 
     with procedures that provide appropriate flexibility to 
     negotiate payment which is in the best interest of the 
     Government.''.
       (3) Subsection (d) is amended by striking out ``preclude 
     such payment, in accordance with--'' and all that follows 
     through ``to such facility therefor'' and inserting in lieu 
     thereof ``preclude such payment to such facility for such 
     care or services''.
       (4) Such section is further amended--
       (A) by redesignating subsection (e) as subsection (g); and
       (B) by inserting after subsection (d) the following new 
     subsections:
       ``(e) The Secretary may make an arrangement that authorizes 
     the furnishing of services by the Secretary under this 
     section to individuals who are not veterans only if the 
     Secretary determines--
       ``(1) that veterans will receive priority under such an 
     arrangement; and
       ``(2) that such an arrangement--
       ``(A) is necessary to maintain an acceptable level and 
     quality of service to veterans at that facility; or

[[Page S11737]]

       ``(B) will result in the improvement of services to 
     eligible veterans at that facility.
       ``(f) Any amount received by the Secretary from a non-
     Federal entity as payment for services provided by the 
     Secretary during a prior fiscal year under an agreement 
     entered into under this section may be obligated by the 
     Secretary during the fiscal year in which the Secretary 
     receives the payment.''.
       (d) Clerical Amendments.--(1) The heading of section 8153 
     is amended to read as follows:

     ``Sec. 8153. Sharing of health-care resources''.

       (2) The item relating to section 8153 in the table of 
     sections at the beginning of chapter 81 is amended to read as 
     follows:

``8153. Sharing of health-care resources.''.

     SEC. 302. IMPROVED EFFICIENCY IN HEALTH CARE RESOURCE 
                   MANAGEMENT.

       (a) Temporary Expansion of Authority for Sharing 
     Agreements.--Section 201 of the Veterans Health Care Act of 
     1992 (Public Law 102-585; 38 U.S.C. 8111 note) is amended--
       (1) by inserting ``(a) Authority.--'' before ``The 
     Secretary of Veterans Affairs''; and
       (2) by adding at the end thereof the following new 
     subsection:
       ``(b) Use of Funds.--Any amount received by the Secretary 
     from a non-Federal entity as payment for services provided by 
     the Secretary during a prior fiscal year under an agreement 
     entered into under this section may be obligated by the 
     Secretary during the fiscal year in which the Secretary 
     receives the payment.''.
       (b) Repeal of Sunset Provision.--(1) Section 204 of such 
     Act (38 U.S.C. 8111 note) is repealed.
       (2) Any services provided pursuant to agreements entered 
     into under section 201 of such Act (38 U.S.C. 8111 note) 
     during the period beginning on October 1, 1996, and ending on 
     the date of the enactment of this Act are hereby ratified.
       (c) Cost Recovery.--Title II of such Act is further amended 
     by adding at the end the following new section:

     ``SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

       ``(a) Right To Recover.--In the case of a primary 
     beneficiary (as described in section 201(a)(2)(B)) who has 
     coverage under a health-plan contract, as defined in section 
     1729(i)(1)(A) of title 38, United States Code, and who is 
     furnished care or services by a Department medical facility 
     pursuant to this title, the United States shall have the 
     right to recover or collect charges for such care or services 
     from such health-plan contract to the extent that the 
     beneficiary (or the provider of the care or services) would 
     be eligible to receive payment for such care or services from 
     such health-plan contract if the care or services had not 
     been furnished by a department or agency of the United 
     States. Any funds received from such health-plan contract 
     shall be credited to funds that have been allotted to the 
     facility that furnished the care or services.
       ``(b) Enforcement.--The right of the United States to 
     recover under such a beneficiary's health-plan contract shall 
     be enforceable in the same manner as that provided by 
     subsections (a)(3), (b), (c)(1), (d), (f), (h), and (i) of 
     section 1729 of title 38, United States Code.''.

     SEC. 303. PERSONNEL FURNISHING SHARED RESOURCES.

       Section 712(b)(2) is amended--
       (1) by striking out ``the sum of--'' and inserting in lieu 
     thereof ``the sum of the following:'';
       (2) by capitalizing the first letter of the first word of 
     each of subparagraphs (A) and (B);
       (3) by striking out ``; and'' at the end of subparagraph 
     (A) and inserting in lieu thereof a period; and
       (4) by adding at the end the following new subparagraph:
       ``(C) The number of such positions in the Department during 
     that fiscal year held by persons involved in providing 
     health-care resources under section 8111 or 8153 of this 
     title or under section 201 of the Veterans Health Care Act of 
     1992 (Public Law 102-585; 106 Stat. 4949; 38 U.S.C. 8111 
     note).''.

     SEC. 304. WAITING PERIOD FOR ADMINISTRATIVE REORGANIZATIONS.

       Section 510(b) is amended--
       (1) in the second sentence, by striking out ``a 90-day 
     period of continuous session of Congress following the date 
     of the submission of the report'' and inserting in lieu 
     thereof ``a 45-day period following the date of the 
     submission of the report, not less than 30 days of which 
     shall be days during which Congress shall have been in 
     continuous session''; and
       (2) in the third sentence, by striking out ``such 90-day 
     period'' and inserting in lieu thereof ``any period of 
     continuity of session''.

     SEC. 305. REPEAL OF LIMITATIONS ON CONTRACTS FOR CONVERSION 
                   OF PERFORMANCE OF ACTIVITIES OF DEPARTMENT 
                   HEALTH-CARE FACILITIES AND REVISED ANNUAL 
                   REPORTING REQUIREMENT.

       Subsection (c) of section 8110 is amended to read as 
     follows:
       ``(c) The Secretary shall include in the materials 
     submitted to Congress each year in support of the budget of 
     the Department for the next fiscal year a report on 
     activities and proposals involving contracting for 
     performance by contractor personnel of work previously 
     performed by Department employees. The report shall--
       ``(1) identify those specific activities that are currently 
     performed at a Department facility by more than 10 Department 
     employees which the Secretary proposes to study for possible 
     contracting involving conversion from performance by 
     Department employees to performance by employees of a 
     contractor; and
       ``(2) identify those specific activities that have been 
     contracted for performance by contractor employees during the 
     prior fiscal year (shown by location, subject, scope of 
     contracts, and savings) and shall describe the effect of such 
     contracts on the quality of delivery of health services 
     during such year.''.
                   Subtitle B--Care of Women Veterans

     SEC. 321. MAMMOGRAPHY QUALITY STANDARDS.

       (a) In General.--(1) Subchapter II of chapter 73 is amended 
     by adding after section 7318 the following new section:

     ``Sec. 7319. Mammography quality standards

       ``(a) A mammogram may not be performed at a Department 
     facility unless that facility is accredited for that purpose 
     by a private nonprofit organization designated by the 
     Secretary. An organization designated by the Secretary under 
     this subsection shall meet the standards for accrediting 
     bodies established under subsection (e) of section 354 of the 
     Public Health Service Act (42 U.S.C. 263b).
       ``(b) The Secretary, in consultation with the Secretary of 
     Health and Human Services, shall prescribe quality assurance 
     and quality control standards relating to the performance and 
     interpretation of mammograms and use of mammogram equipment 
     and facilities of the Department of Veterans Affairs 
     consistent with the requirements of section 354(f)(1) of the 
     Public Health Service Act. Such standards shall be no less 
     stringent than the standards prescribed by the Secretary of 
     Health and Human Services under section 354(f) of the Public 
     Health Service Act.
       ``(c)(1) The Secretary, to ensure compliance with the 
     standards prescribed under subsection (b), shall provide for 
     an annual inspection of the equipment and facilities used by 
     and in Department health care facilities for the performance 
     of mammograms. Such inspections shall be carried out in a 
     manner consistent with the inspection of certified facilities 
     by the Secretary of Health and Human Services under section 
     354(g) of the Public Health Service Act.
       ``(2) The Secretary may not provide for an inspection under 
     paragraph (1) to be performed by a State agency.
       ``(d) The Secretary shall ensure that mammograms performed 
     for the Department under contract with any non-Department 
     facility or provider conform to the quality standards 
     prescribed by the Secretary of Health and Human Services 
     under section 354 of the Public Health Service Act.
       ``(e) For the purposes of this section, the term 
     `mammogram' has the meaning given such term in paragraph (5) 
     of section 354(a) of the Public Health Service Act.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     7318 the following new item:

``7319. Mammography quality standards.''.

       (b) Deadline for Prescribing Standards.--The Secretary of 
     Veterans Affairs shall prescribe standards under subsection 
     (b) of section 7319 of title 38, United States Code, as added 
     by subsection (a), not later than the end of the 120-day 
     period beginning on the date of the enactment of this Act.
       (c) Implementation Report.--The Secretary shall submit to 
     the Committees on Veterans' Affairs of the Senate and House 
     of Representatives a report on the Secretary's implementation 
     of section 7319 of title 38, United States Code, as added by 
     subsection (a). The report shall be submitted not later than 
     120 days after the date of the enactment of this Act.

     SEC. 322. PATIENT PRIVACY FOR WOMEN PATIENTS.

       (a) Identification of Deficiencies.--The Secretary of 
     Veterans Affairs shall conduct a survey of each medical 
     center under the jurisdiction of the Secretary to identify 
     deficiencies relating to patient privacy afforded to women 
     patients in the clinical areas at each such center which may 
     interfere with appropriate treatment of such patients.
       (b) Correction of Deficiencies.--The Secretary shall ensure 
     that plans and, where appropriate, interim steps to correct 
     the deficiencies identified in the survey conducted under 
     subsection (a) are developed and are incorporated into the 
     Department's construction planning processes and, in cases in 
     which it is cost-effective to do so, are given a high 
     priority.
       (c) Reports to Congress.--The Secretary shall compile an 
     annual inventory, by medical center, of deficiencies 
     identified under subsection (a) and of plans and, where 
     appropriate, interim steps, to correct such deficiencies. The 
     Secretary shall submit to the Committees on Veterans' Affairs 
     of the Senate and House of Representatives, not later than 
     October 1, 1997, and not later than October 1 each year 
     thereafter through 1999 a report on such deficiencies. The 
     Secretary shall include in such report the inventory compiled 
     by the Secretary, the proposed corrective plans, and the 
     status of such plans.

     SEC. 323. ASSESSMENT OF USE BY WOMEN VETERANS OF DEPARTMENT 
                   HEALTH SERVICES.

       (a) Reports to Under Secretary for Health.--The Center for 
     Women Veterans of the Department of Veterans Affairs 
     (established under section 509 of Public Law 103-446), in 
     consultation with the Advisory Committee on Women Veterans, 
     shall assess the

[[Page S11738]]

     use by women veterans of health services through the 
     Department of Veterans Affairs, including counseling for 
     sexual trauma and mental health services. The Center shall 
     submit to the Under Secretary for Health of the Department of 
     Veterans Affairs a report not later than April 1, 1997, and 
     April 1 of each of the two following years, on--
       (1) the extent to which women veterans described in 
     paragraphs (1) and (2) of section 1710(a) of title 38, United 
     States Code, fail to seek, or face barriers in seeking, 
     health services through the Department, and the reasons 
     therefor; and
       (2) recommendations, if indicated, for encouraging greater 
     use of such services, including (if appropriate) public 
     service announcements and other outreach efforts.
       (b) Reports to Congressional Committees.--Not later than 
     July 1, 1997, and July 1 of each of the two following years, 
     the Secretary of Veterans Affairs shall submit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives a report containing--
       (1) the most recent report of the Center for Women Veterans 
     under subsection (a);
       (2) the views of the Under Secretary for Health on such 
     report's findings and recommendations; and
       (3) a description of the steps being taken by the Secretary 
     to remedy any problems described in the report.

     SEC. 324. REPORTING REQUIREMENTS.

       (a) Extension of Annual Report Requirement.--Section 107(a) 
     of the Veterans Health Care Act of 1992 (Public Law 102-585; 
     106 Stat. 4947) is amended by striking out ``Not later than 
     January 1, 1993, January 1, 1994, and January 1, 1995'' and 
     inserting in lieu thereof ``Not later than January 1 of 1993 
     and each year thereafter through 1998''.
       (b) Report on Health Care and Research.--Section 107(b) of 
     such Act is amended--
       (1) in paragraph (2)(A), by inserting ``(including 
     information on the number of inpatient stays and the number 
     of outpatient visits through which such services were 
     provided)'' after ``facility''; and
       (2) by adding at the end the following new paragraph:
       ``(5) A description of the actions taken by the Secretary 
     to foster and encourage the expansion of such research.''.
       Subtitle C--Readjustment Counseling and Mental Health Care

     SEC. 331. EXPANSION OF ELIGIBILITY FOR READJUSTMENT 
                   COUNSELING AND CERTAIN RELATED COUNSELING 
                   SERVICES.

       (a) Expansion of Eligibility.--Subsection (a) of section 
     1712A is amended to read as follows:
       ``(a)(1)(A) Upon the request of any veteran referred to in 
     subparagraph (B), the Secretary shall furnish counseling to 
     the veteran to assist the veteran in readjusting to civilian 
     life. Such counseling may include a general mental and 
     psychological assessment of the veteran to ascertain whether 
     such veteran has mental or psychological problems associated 
     with readjustment to civilian life.
       ``(B) Subparagraph (A) applies to the following veterans:
       ``(i) Any veteran who served on active duty--
       ``(I) in a theater of combat operations (as determined by 
     the Secretary in consultation with the Secretary of Defense) 
     during the Vietnam era; or
       ``(II) after May 7, l975, in an area at a time during which 
     hostilities occurred in that area.
       ``(ii) Any veteran (other than a veteran covered by clause 
     (i)) who served on active duty during the Vietnam era who 
     seeks or is furnished such counseling before January 1, 2000.
       ``(2)(A) Upon the request of any veteran (other than a 
     veteran covered by paragraph (1)) who served in the active 
     military, naval, or air service in a theater of combat 
     operations (as so determined) during a period of war, or in 
     any other area during a period in which hostilities (as 
     defined in subparagraph (B)) occurred in such area, the 
     Secretary may furnish counseling to the veteran to assist the 
     veteran in readjusting to civilian life.
       ``(B) For the purposes of subparagraph (A), the term 
     `hostilities' means an armed conflict in which the members of 
     the Armed Forces are subjected to danger comparable to the 
     danger to which members of the Armed Forces have been 
     subjected in combat with enemy armed forces during a period 
     of war, as determined by the Secretary in consultation with 
     the Secretary of Defense.''.
       (b) Repeal of Referral Provisions.--Subsection (c) of such 
     section is repealed.

     SEC. 332. REPORTS RELATING TO VET CENTERS.

       (a) Report on Collocation of Vet Centers and Department 
     Outpatient Clinics.--(1) Not later than six months after the 
     date of the enactment of this Act, the Secretary of Veterans 
     Affairs shall submit to the Committees on Veterans' Affairs 
     of the Senate and House of Representatives a report on the 
     feasibility and desirability of providing for the collocation 
     of Vet Centers and outpatient clinics (including rural mobile 
     clinics) of the Department of Veterans Affairs as current 
     leases for such centers and clinics expire.
       (2) The report shall include an assessment of the 
     following:
       (A) The results of any collocation of Vet Centers and 
     outpatient clinics carried out by the Secretary before the 
     date of the enactment of this Act, including the effects of 
     such collocation on the quality of care provided at such 
     centers and clinics.
       (B) The effect of such collocation on the capacity of such 
     centers and clinics to carry out their primary mission.
       (C) The extent to which such collocation will impair the 
     operational independence or administrative integrity of such 
     centers and clinics.
       (D) The feasibility of combining the services provided by 
     such centers and clinics in the course of such collocation.
       (E) The advisability of the collocation of centers and 
     clinics of significantly different size.
       (F) The effect of the locations (including urban and rural 
     locations) of the centers and clinics on the feasibility and 
     desirability of such collocation.
       (G) The amount of any costs savings to be achieved by 
     Department as a result of such collocation.
       (H) Any other matter that the Secretary considers 
     appropriate.
       (b) Report on Provision of Limited Health Care Services at 
     Readjustment Counseling Centers.--(1) Not later than six 
     months after the date of the enactment of this Act, the 
     Secretary of Veterans Affairs shall submit to the Committees 
     on Veterans' Affairs of the Senate and House of 
     Representatives a report on the feasibility and desirability 
     of providing a limited battery of health care services 
     (including ambulatory services and health care screening 
     services) to veterans at Department of Veterans Affairs 
     readjustment counseling centers.
       (2) The report shall include a discussion of the following:
       (A) The effect on the advisability of providing health care 
     services at readjustment counseling centers of the geographic 
     location of such centers, including the urban location and 
     rural location of such centers and the proximity of such 
     centers to Department of Veterans Affairs medical facilities.
       (B) The effect on the advisability of providing such 
     services at such centers of the type and level of services to 
     be provided, and the demographic characteristics (including 
     age, socio-economic status, ethnicity, and sex) of veterans 
     likely to be provided the services.
       (C) The effect of providing such services at such centers 
     on the readjustment counseling center program in general and 
     on the efficiency and autonomy of the clinical and 
     administrative operations of the readjustment counseling 
     centers in particular.
       (D) Any other matter that the Secretary considers 
     appropriate.
       (c) Rule of Construction.--Nothing in this section is 
     intended to preclude the Secretary, during the period before 
     the submission of the reports under this section, from 
     providing limited health care services at Vet Centers.

     SEC. 333. ADVISORY COMMITTEE ON THE READJUSTMENT OF VETERANS.

       (a) In General.--(1) Subchapter III of chapter 5 is amended 
     by inserting after section 544 the following new section:

     ``Sec. 545. Advisory Committee on the Readjustment of 
       Veterans

       ``(a)(1) There is in the Department the Advisory Committee 
     on the Readjustment of Veterans (hereinafter in this section 
     referred to as the `Committee').
       ``(2) The Committee shall consist of not more than 18 
     members appointed by the Secretary from among individuals 
     who--
       ``(A) have demonstrated significant civic or professional 
     achievement; and
       ``(B) have experience with the provision of veterans 
     benefits and services by the Department.
       ``(3) The Secretary shall seek to ensure that members 
     appointed to the Committee include individuals from a wide 
     variety of geographic areas and ethnic backgrounds, 
     individuals from veterans service organizations, individuals 
     with combat experience, and women.
       ``(4) The Secretary shall determine the terms of service 
     and pay and allowances of the members of the Committee, 
     except that a term of service may not exceed two years. The 
     Secretary may reappoint any member for additional terms of 
     service.
       ``(b)(1) The Secretary shall, on a regular basis, consult 
     with and seek the advice of the Committee with respect to the 
     provision by the Department of benefits and services to 
     veterans in order to assist veterans in the readjustment to 
     civilian life.
       ``(2)(A) In providing advice to the Secretary under this 
     subsection, the Committee shall--
       ``(i) assemble and review information relating to the needs 
     of veterans in readjusting to civilian life;
       ``(ii) provide information relating to the nature and 
     character of psychological problems arising from service in 
     the Armed Forces;
       ``(iii) provide an on-going assessment of the effectiveness 
     of the policies, organizational structures, and services of 
     the Department in assisting veterans in readjusting to 
     civilian life; and
       ``(iv) provide on-going advice on the most appropriate 
     means of responding to the readjustment needs of veterans in 
     the future.
       ``(B) In carrying out its duties under subparagraph (A), 
     the Committee shall take into special account the needs of 
     veterans who have served in a theater of combat operations.

[[Page S11739]]

       ``(c)(1) Not later than March 31 of each year, the 
     Committee shall submit to the Secretary a report on the 
     programs and activities of the Department that relate to the 
     readjustment of veterans to civilian life. Each such report 
     shall include--
       ``(A) an assessment of the needs of veterans with respect 
     to readjustment to civilian life;
       ``(B) a review of the programs and activities of the 
     Department designed to meet such needs; and
       ``(C) such recommendations (including recommendations for 
     administrative and legislative action) as the Committee 
     considers appropriate.
       ``(2) Not later than 90 days after the receipt of a report 
     under paragraph (1), the Secretary shall transmit to the 
     Committees on Veterans' Affairs of the Senate and House of 
     Representatives a copy of the report, together with any 
     comments and recommendations concerning the report that the 
     Secretary considers appropriate.
       ``(3) The Committee may also submit to the Secretary such 
     other reports and recommendations as the Committee considers 
     appropriate.
       ``(4) The Secretary shall submit with each annual report 
     submitted to the Congress pursuant to section 529 of this 
     title a summary of all reports and recommendations of the 
     Committee submitted to the Secretary since the previous 
     annual report of the Secretary submitted pursuant to that 
     section.
       ``(d)(1) Except as provided in paragraph (2), the 
     provisions of the Federal Advisory Committee Act (5 U.S.C. 
     App.) shall apply to the activities of the Committee under 
     this section.
       ``(2) Section 14 of such Act shall not apply to the 
     Committee.''.
       (2) The table of sections at the beginning of chapter 5 is 
     amended by inserting after the item relating to section 544 
     the following new item:

``545. Advisory Committee on the Readjustment of Veterans.''.

       (b) Original Members.--(1) Notwithstanding subsection 
     (a)(2) of section 545 of title 38, United States Code (as 
     added by subsection (a)), the members of the Advisory 
     Committee on the Readjustment of Vietnam and Other War 
     Veterans on the date of the enactment of this Act shall be 
     the original members of the advisory committee recognized 
     under such section.
       (2) The original members shall so serve until the Secretary 
     of Veterans Affairs carries out appointments under such 
     subsection (a)(2). The Secretary of Veterans Affairs shall 
     carry out such appointments as soon after such date as is 
     practicable. The Secretary may make such appointments from 
     among such original members.

     SEC. 334. CENTERS FOR MENTAL ILLNESS RESEARCH, EDUCATION, AND 
                   CLINICAL ACTIVITIES.

       (a) In General.--(1) Subchapter II of chapter 73 is amended 
     by adding after section 7319, as added by section 321(a)(1), 
     the following new section:

     ``Sec. 7320. Centers for mental illness research, education, 
       and clinical activities

       ``(a) The purpose of this section is to provide for the 
     improvement of the provision of health-care services and 
     related counseling services to eligible veterans suffering 
     from mental illness (especially mental illness related to 
     service-related conditions) through--
       ``(1) the conduct of research (including research on 
     improving mental health service facilities of the Department 
     and on improving the delivery of mental health services by 
     the Department);
       ``(2) the education and training of health care personnel 
     of the Department; and
       ``(3) the development of improved models and systems for 
     the furnishing of mental health services by the Department.
       ``(b)(1) The Secretary shall establish and operate centers 
     for mental illness research, education, and clinical 
     activities. Such centers shall be established and operated by 
     collaborating Department facilities as provided in subsection 
     (c)(1). Each such center shall function as a center for--
       ``(A) research on mental health services;
       ``(B) the use by the Department of specific models for 
     furnishing services to treat serious mental illness;
       ``(C) education and training of health-care professionals 
     of the Department; and
       ``(D) the development and implementation of innovative 
     clinical activities and systems of care with respect to the 
     delivery of such services by the Department.
       ``(2) The Secretary shall, upon the recommendation of the 
     Under Secretary for Health, designate the centers under this 
     section. In making such designations, the Secretary shall 
     ensure that the centers designated are located in various 
     geographic regions of the United States. The Secretary may 
     designate a center under this section only if--
       ``(A) the proposal submitted for the designation of the 
     center meets the requirements of subsection (c);
       ``(B) the Secretary makes the finding described in 
     subsection (d); and
       ``(C) the peer review panel established under subsection 
     (e) makes the determination specified in subsection (e)(3) 
     with respect to that proposal.
       ``(3) Not more than five centers may be designated under 
     this section.
       ``(4) The authority of the Secretary to establish and 
     operate centers under this section is subject to the 
     appropriation of funds for that purpose.
       ``(c) A proposal submitted for the designation of a center 
     under this section shall--
       ``(1) provide for close collaboration in the establishment 
     and operation of the center, and for the provision of care 
     and the conduct of research and education at the center, by a 
     Department facility or facilities in the same geographic area 
     which have a mission centered on care of the mentally ill and 
     a Department facility in that area which has a mission of 
     providing tertiary medical care;
       ``(2) provide that no less than 50 percent of the funds 
     appropriated for the center for support of clinical care, 
     research, and education will be provided to the collaborating 
     facility or facilities that have a mission centered on care 
     of the mentally ill; and
       ``(3) provide for a governance arrangement between the 
     collaborating Department facilities which ensures that the 
     center will be established and operated in a manner aimed at 
     improving the quality of mental health care at the 
     collaborating facility or facilities which have a mission 
     centered on care of the mentally ill.
       ``(d) The finding referred to in subsection (b)(2)(B) with 
     respect to a proposal for designation of a site as a location 
     of a center under this section is a finding by the Secretary, 
     upon the recommendation of the Under Secretary for Health, 
     that the facilities submitting the proposal have developed 
     (or may reasonably be anticipated to develop) each of the 
     following:
       ``(1) An arrangement with an accredited medical school that 
     provides education and training in psychiatry and with which 
     one or more of the participating Department facilities is 
     affiliated under which medical residents receive education 
     and training in psychiatry through regular rotation through 
     the participating Department facilities so as to provide such 
     residents with training in the diagnosis and treatment of 
     mental illness.
       ``(2) An arrangement with an accredited graduate program of 
     psychology under which students receive education and 
     training in clinical, counseling, or professional psychology 
     through regular rotation through the participating Department 
     facilities so as to provide such students with training in 
     the diagnosis and treatment of mental illness.
       ``(3) An arrangement under which nursing, social work, 
     counseling, or allied health personnel receive training and 
     education in mental health care through regular rotation 
     through the participating Department facilities.
       ``(4) The ability to attract scientists who have 
     demonstrated achievement in research--
        ``(A) into the evaluation of innovative approaches to the 
     design of mental health services; or
       ``(B) into the causes, prevention, and treatment of mental 
     illness.
       ``(5) The capability to evaluate effectively the activities 
     of the center, including activities relating to the 
     evaluation of specific efforts to improve the quality and 
     effectiveness of mental health services provided by the 
     Department at or through individual facilities.
       ``(e)(1) In order to provide advice to assist the Secretary 
     and the Under Secretary for Health to carry out their 
     responsibilities under this section, the official within the 
     central office of the Veterans Health Administration 
     responsible for mental health and behavioral sciences matters 
     shall establish a peer review panel to assess the scientific 
     and clinical merit of proposals that are submitted to the 
     Secretary for the designation of centers under this section.
       ``(2) The panel shall consist of experts in the fields of 
     mental health research, education and training, and clinical 
     care. Members of the panel shall serve as consultants to the 
     Department.
       ``(3) The panel shall review each proposal submitted to the 
     panel by the official referred to in paragraph (1) and shall 
     submit to that official its views on the relative scientific 
     and clinical merit of each such proposal. The panel shall 
     specifically determine with respect to each such proposal 
     whether that proposal is among those proposals which have met 
     the highest competitive standards of scientific and clinical 
     merit.
       ``(4) The panel shall not be subject to the Federal 
     Advisory Committee Act (5 U.S.C. App.).
       ``(f) Clinical and scientific investigation activities at 
     each center established under this section--
       ``(1) may compete for the award of funding from amounts 
     appropriated for the Department of Veterans Affairs medical 
     and prosthetics research account; and
       ``(2) shall receive priority in the award of funding from 
     such account insofar as funds are awarded to projects and 
     activities relating to mental illness.
       ``(g) The Under Secretary for Health shall ensure that at 
     least three centers designated under this section emphasize 
     research into means of improving the quality of care for 
     veterans suffering from mental illness through the 
     development of community-based alternatives to institutional 
     treatment for such illness.
       ``(h) The Under Secretary for Health shall ensure that 
     information produced by the research, education and training, 
     and clinical activities of centers established under this 
     section that may be useful for other activities of the 
     Veterans Health Administration is disseminated throughout the 
     Veterans Health Administration. Such dissemination shall be 
     made through publications, through programs of continuing 
     medical and related education provided through regional 
     medical

[[Page S11740]]

     education centers under subchapter VI of chapter 74 of this 
     title, and through other means. Such programs of continuing 
     medical education shall receive priority in the award of 
     funding.
       ``(i) The official within the central office of the 
     Veterans Health Administration responsible for mental health 
     and behavioral sciences matters shall be responsible for 
     supervising the operation of the centers established pursuant 
     to this section and shall provide for ongoing evaluation of 
     the centers and their compliance with the requirements of 
     this section.
       ``(j)(1) There are authorized to be appropriated to the 
     Department of Veterans Affairs for the basic support of the 
     research and education and training activities of centers 
     established pursuant to this section amounts as follows:
       ``(A) $3,125,000 for fiscal year 1998.
       ``(B) $6,250,000 for each of fiscal years 1999 through 
     2001.
       ``(2) In addition to funds appropriated for a fiscal year 
     pursuant to the authorization of appropriations in paragraph 
     (1), the Under Secretary for Health shall allocate to such 
     centers from other funds appropriated for that fiscal year 
     generally for the Department of Veterans Affairs medical care 
     account and the Department of Veterans Affairs medical and 
     prosthetics research account such amounts as the Under 
     Secretary for Health determines appropriate to carry out the 
     purposes of this section.''.
       (2) The table of sections at the beginning of chapter 73 is 
     amended by inserting after the item relating to section 7319, 
     as added by section 321(a)(2), the following new item:

``7320. Centers for mental illness research, education, and clinical 
              activities.''.

       (b) Annual Reports.--Not later than February 1 of each of 
     1999, 2000, 2001, and 2002, the Secretary of Veterans Affairs 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report on the status 
     and activities during the previous fiscal year of the centers 
     for mental illness research, education, and clinical 
     activities established pursuant to section 7320 of title 38, 
     United States Code (as added by subsection (a)). Each such 
     report shall include the following:
       (1) A description of the activities carried out at each 
     center and the funding provided for such activities.
       (2) A description of the advances made at each of the 
     participating facilities of the center in research, education 
     and training, and clinical activities relating to mental 
     illness in veterans.
       (3) A description of the actions taken by the Under 
     Secretary for Health pursuant to subsection (h) of that 
     section (as so added) to disseminate information derived from 
     such activities throughout the Veterans Health 
     Administration.
       (4) The Secretary's evaluations of the effectiveness of the 
     centers in fulfilling the purposes of the centers.
       (c) Implementation.--The Secretary of Veterans Affairs 
     shall designate at least one center under section 7320 of 
     title 38, United States Code, not later than January 1, 1998.

     SEC. 335. COMMITTEE ON CARE OF SEVERELY CHRONICALLY MENTALLY 
                   ILL VETERANS.

       (a) Establishment.--Subchapter II of chapter 73 is amended 
     by adding after section 7320, as added by section 334(a)(1), 
     the following new section:

     ``Sec. 7321. Committee on Care of Severely Chronically 
       Mentally Ill Veterans

       ``(a) The Secretary, acting through the Under Secretary for 
     Health, shall establish in the Veterans Health Administration 
     a Committee on Care of Severely Chronically Mentally Ill 
     Veterans. The Under Secretary shall appoint employees of the 
     Department with expertise in the care of the chronically 
     mentally ill to serve on the committee.
       ``(b) The committee shall assess, and carry out a 
     continuing assessment of, the capability of the Veterans 
     Health Administration to meet effectively the treatment and 
     rehabilitation needs of mentally ill veterans whose mental 
     illness is severe and chronic and who are eligible for health 
     care furnished by the Department, including the needs of such 
     veterans who are women. In carrying out that responsibility, 
     the committee shall--
       ``(1) evaluate the care provided to such veterans through 
     the Veterans Health Administration;
       ``(2) identify systemwide problems in caring for such 
     veterans in facilities of the Veterans Health Administration;
       ``(3) identify specific facilities within the Veterans 
     Health Administration at which program enrichment is needed 
     to improve treatment and rehabilitation of such veterans; and
       ``(4) identify model programs which the committee considers 
     to have been successful in the treatment and rehabilitation 
     of such veterans and which should be implemented more widely 
     in or through facilities of the Veterans Health 
     Administration.
       ``(c) The committee shall--
       ``(1) advise the Under Secretary regarding the development 
     of policies for the care and rehabilitation of severely 
     chronically mentally ill veterans; and
       ``(2) make recommendations to the Under Secretary--
       ``(A) for improving programs of care of such veterans at 
     specific facilities and throughout the Veterans Health 
     Administration;
       ``(B) for establishing special programs of education and 
     training relevant to the care of such veterans for employees 
     of the Veterans Health Administration;
       ``(C) regarding research needs and priorities relevant to 
     the care of such veterans; and
       ``(D) regarding the appropriate allocation of resources for 
     all such activities.
       ``(d)(1) Not later than April 1, 1997, the Secretary shall 
     submit to the Committees on Veterans' Affairs of the Senate 
     and House of Representatives a report on the implementation 
     of this section. The report shall include the following:
       ``(A) A list of the members of the committee.
       ``(B) The assessment of the Under Secretary for Health, 
     after review of the initial findings of the committee, 
     regarding the capability of the Veterans Health 
     Administration, on a systemwide and facility-by-facility 
     basis, to meet effectively the treatment and rehabilitation 
     needs of severely chronically mentally ill veterans who are 
     eligible for Department care.
       ``(C) The plans of the committee for further assessments.
       ``(D) The findings and recommendations made by the 
     committee to the Under Secretary for Health and the views of 
     the Under Secretary on such findings and recommendations.
       ``(E) A description of the steps taken, plans made (and a 
     timetable for their execution), and resources to be applied 
     toward improving the capability of the Veterans Health 
     Administration to meet effectively the treatment and 
     rehabilitation needs of severely chronically mentally ill 
     veterans who are eligible for Department care.
       ``(2) Not later than February 1, 1998, and February 1 of 
     each of the three following years, the Secretary shall submit 
     to the Committees on Veterans' Affairs of the Senate and 
     House of Representatives a report containing information 
     updating the reports submitted under this subsection before 
     the submission of such report.''.
       (b) Clerical Amendment.--The table of sections at the 
     beginning of chapter 73 is amended by inserting after the 
     item relating to section 7320, as added by section 334(a)(2) 
     the following new item:

``7321. Committee on Care of Severely Chronically Mentally Ill 
              Veterans.''.
                      Subtitle D--Other Provisions

     SEC. 341. HOSPICE CARE STUDY.

       (a) Study Required.--The Secretary of Veterans Affairs 
     shall conduct a research study to determine the desirability 
     of the Secretary furnishing hospice care to terminally ill 
     veterans and to evaluate the most cost effective and 
     efficient way to do so. The Secretary shall carry out the 
     study using resources and personnel of the Department.
       (b) Conduct of Study.--In carrying out the study required 
     by subsection (a), the Secretary shall--
       (1) evaluate the programs, and the program models, through 
     which the Secretary furnishes hospice care services within or 
     through facilities of the Department of Veterans Affairs and 
     the programs and program models through which non-Department 
     facilities provide such services;
       (2) assess the satisfaction of patients, and family members 
     of patients, in each of the program models covered by 
     paragraph (1);
       (3) compare the costs (or range of costs) of providing care 
     through each of the program models covered by paragraph (1); 
     and
       (4) identify any barriers to providing, procuring, or 
     coordinating hospice services through any of the program 
     models covered by paragraph (1).
       (c) Program Models.--For purposes of subsection (b)(1), the 
     Secretary shall evaluate a variety of types of models for 
     delivery of hospice care, including the following:
       (1) Direct furnishing of full hospice care by the 
     Secretary.
       (2) Direct furnishing of some hospice services by the 
     Secretary.
       (3) Contracting by the Secretary for the furnishing of 
     hospice care, with a commitment that the Secretary will 
     provide any further required hospital care for the patient.
       (4) Contracting for all required care to be furnished 
     outside the Department.
       (5) Referral of the patient for hospice care without a 
     contract.
       (d) Report.--Not later than April 1, 1998, the Secretary 
     shall submit to the Committees on Veterans' Affairs of the 
     Senate and House of Representatives a report on the research 
     study. The report shall set forth the Secretary's findings 
     and recommendations. The Secretary shall include in the 
     report information on the extent to which the Secretary 
     advises veterans concerning their eligibility for hospice 
     care and information on the number of veterans (as of the 
     time of the report) who are in each model of hospice care 
     described in subsection (c) and the average cost per patient 
     of hospice care for each such model.

     SEC. 342. PAYMENT TO STATES OF PER DIEM FOR VETERANS 
                   RECEIVING ADULT DAY HEALTH CARE.

       (a) Payment of Per Diem for Veterans Receiving Adult Day 
     Care.--Section 1741 is amended--
       (1) by inserting ``(1)'' after ``(a)'';
       (2) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), respectively; and
       (3) by adding at the end the following new paragraph (2):
       ``(2) The Secretary may pay each State per diem at a rate 
     determined by the Secretary

[[Page S11741]]

     for each veteran receiving adult day health care in a State 
     home, if such veteran is eligible for such care under laws 
     administered by the Secretary.''.
       (b) Assistance to States for Construction of Adult Day Care 
     Facilities.--(1) Section 8131(3) is amended by inserting 
     ``adult day health,'' before ``or hospital care''.
       (2) Section 8132 is amended by inserting ``adult day 
     health,'' before ``or hospital care''.
       (3) Section 8135(b) is amended--
       (A) in paragraph (2)(C), by inserting ``or adult day health 
     care facilities'' after ``domiciliary beds''; and
       (B) in paragraph (3)(A), by inserting ``or construction 
     (other than new construction) of adult day health care 
     buildings'' before the semicolon.

     SEC. 343. RESEARCH CORPORATIONS.

       (a) Renewal of Authority.--Section 7368 is amended by 
     striking out ``December 31, 1992'' and inserting in lieu 
     thereof ``December 31, 2000''.
       (b) Clarification of Tax-Exempt Status.--Sections 7361(b) 
     and 7363(c) are amended by striking out ``section 501(c)(3) 
     of''.
       (c) Periodic Audits.--Subsection (b) of section 7366 is 
     amended by striking out ``The corporation'' in the second 
     sentence and all that follows through ``shall include that 
     report'' and inserting in lieu thereof the following: ``A 
     corporation with revenues in excess of $300,000 for any year 
     shall obtain an audit of the corporation for that year. A 
     corporation with annual revenues between $10,000 and $300,000 
     shall obtain an independent audit of the corporation at least 
     once every three years. Any audit under the preceding 
     sentences shall be performed by an independent auditor. The 
     corporation shall include the most recent such audit''.
       (d) Compliance With Conflict of Interest Laws and 
     Regulations.--Subsection (c)(2) of section 7366 is amended by 
     striking out ``an annual statement signed by the director or 
     employee certifying that the director or'' and inserting in 
     lieu thereof ``a statement signed by the executive director 
     of the corporation certifying that each director and''.
       (e) Revised Reporting Requirement.--Subsection (d) of 
     section 7366 is amended to read as follows:
       ``(d) The Secretary shall submit to the Committees on 
     Veterans' Affairs of the Senate and House of Representatives 
     an annual report on the corporations established under this 
     subchapter. The report shall set forth the following 
     information:
       ``(1) The location of each corporation.
       ``(2) The amount received by each corporation during the 
     previous year, including--
       ``(A) the total amount received;
       ``(B) the amount received from governmental entities;
       ``(C) the amount received from all other sources; and
       ``(D) if the amount received from a source referred to in 
     subparagraph (C) exceeded $25,000, information that 
     identifies the source.
       ``(3) The amount expended by each corporation during the 
     year, including--
       ``(A) the amount expended for salary for research staff and 
     for salary for support staff;
       ``(B) the amount expended for direct support of research; 
     and
       ``(C) if the amount expended with respect to any payee 
     exceeded $35,000, information that identifies the payee.''.

     SEC. 344. VETERANS HEALTH ADMINISTRATION HEADQUARTERS.

       Section 7306 is amended by adding at the end the following 
     new subsection:
       ``(f) In organizing the Office and appointing persons to 
     positions in the Office, the Under Secretary shall ensure 
     that--
       ``(1) the Office is staffed so as to provide the Under 
     Secretary, through a designated clinician in the appropriate 
     discipline in each instance, with expertise and direct policy 
     guidance on--
       ``(A) unique programs operated by the Administration to 
     provide for the specialized treatment and rehabilitation of 
     disabled veterans (including blind rehabilitation, care of 
     spinal cord dysfunction, mental illness, and long-term care); 
     and
       ``(B) the programs established under section 1712A of this 
     title; and
       ``(2) with respect to the programs established under 
     section 1712A of this title, a clinician with appropriate 
     expertise in those programs is responsible to the Under 
     Secretary for the management of those programs.''.

     SEC. 345. DISBURSEMENT AGREEMENTS RELATING TO MEDICAL 
                   RESIDENTS AND INTERNS.

       Section 7406(c) is amended--
       (1) by striking out ``Department hospital'' each place it 
     appears and inserting in lieu thereof ``Department facility 
     furnishing hospital care or medical services'';
       (2) by striking out ``participating hospital'' in paragraph 
     (4)(C) and inserting in lieu thereof ``participating 
     facility''; and
       (3) by striking out ``hospital'' both places it appears in 
     paragraph (5) and inserting in lieu thereof ``facility''.

     SEC. 346. AUTHORITY TO SUSPEND SPECIAL PAY AGREEMENTS FOR 
                   PHYSICIANS AND DENTISTS WHO ENTER RESIDENCY 
                   TRAINING PROGRAMS.

       Section 7432(b)(2) is amended--
       (1) by inserting ``(A)'' after ``(2)''; and
       (2) by adding at the end the following:
       ``(B) The Secretary may suspend a special pay agreement 
     entered into under this section in the case of a physician or 
     dentist who, having entered into the special pay agreement, 
     enters a residency training program. Any such suspension 
     shall terminate when the physician or dentist completes, 
     withdraws from, or is no longer a participant in the program. 
     During the period of such a suspension, the physician or 
     dentist is not subject to the provisions of paragraph (1).''.

     SEC. 347. REMUNERATED OUTSIDE PROFESSIONAL ACTIVITIES BY 
                   VETERANS HEALTH ADMINISTRATION PERSONNEL.

       (a) Authority.--Subsection (b) of section 7423 is amended--
       (1) by striking out paragraph (1); and
       (2) by redesignating paragraphs (2) through (6) as 
     paragraphs (1) through (5), respectively.
       (b) Conforming Amendment.--Subsection (c) of such section 
     is amended in the matter preceding paragraph (1) by striking 
     out ``subsection (b)(6)'' and inserting in lieu thereof 
     ``subsection (b)(5)''.

     SEC. 348. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, 
                   MILWAUKEE COUNTY, WISCONSIN.

       (a) Modification of Reversionary Interest.--The Secretary 
     of Veterans Affairs is authorized to execute such instruments 
     as may be necessary to modify the conditions under which the 
     land described in subsection (b) will revert to the United 
     States in order--
       (1) to permit Milwaukee County, Wisconsin, to grant all or 
     part of such land to another party with a condition on such 
     grant that the grantee use such land only for civic and 
     recreational purposes; and
       (2) to provide that the conditions under which title to all 
     or any part of such land reverts to the United States are 
     stated so that any such reversion would occur at the option 
     of the United States.
       (b) Description of Land.--The land covered by this section 
     is the tract of 28 acres of land, more or less, conveyed to 
     Milwaukee County, Wisconsin, pursuant to the Act entitled 
     ``An Act authorizing the Administrator of Veterans' Affairs 
     to convey certain property to Milwaukee County, Wisconsin'', 
     approved August 27, 1954 (68 Stat. 866).
       (c) General Authorities.--The Secretary may carry out this 
     section subject to such terms and conditions (including 
     reservations of rights for the United States) as the 
     Secretary considers necessary to protect the interests of the 
     United States. In carrying out this section, the Secretary 
     may eliminate any existing covenant or restriction with 
     respect to the tract of land described in subsection (b) 
     which the Secretary determines to be no longer necessary to 
     protect the interests of the United States.

     SEC. 349. MODIFICATION OF RESTRICTIONS ON REAL PROPERTY, 
                   CHEYENNE, WYOMING.

       (a) Modification of Reversionary Interest.--The Secretary 
     of Veterans Affairs of Veterans Affairs is authorized to 
     execute such instruments as may be necessary to modify the 
     conditions under which the land described in subsection (b) 
     will revert to the United States in order to permit the City 
     of Cheyenne, Wyoming, to grant all or part of such land to 
     the First Cheyenne Federal Credit Union (formerly known as 
     the Cheyenne VAF Federal Credit Union) with a condition on 
     such grant that the First Cheyenne Federal Credit Union use 
     such land only for the purpose of constructing a building to 
     house its operations.
       (b) Description of Land.--The land covered by this section 
     is the tract of 27 acres of land, more or less, conveyed to 
     the City of Cheyenne, Wyoming, pursuant to the Act entitled 
     ``An Act authorizing the Administrator of Veterans' Affairs 
     to convey certain property to the City of Cheyenne, 
     Wyoming'', approved November 8, 1965 (79 Stat. 1304).
       (c) Terms of Reversionary Interest.--In carrying out this 
     section, the Secretary may cause the statement of the 
     conditions under which title to all or any part of the land 
     described in subsection (b) reverts to the United States to 
     be revised so that any such reversion would occur at the 
     option of the United States.
       (d) General Authorities.--The Secretary may carry out this 
     section subject to such terms and conditions (including 
     reservations of rights for the United States) as the 
     Secretary considers necessary to protect the interests of the 
     United States. In carrying out this section, the Secretary 
     may eliminate any existing covenant or restriction with 
     respect to the tract of land described in subsection (b) 
     which the Secretary determines to be no longer necessary to 
     protect the interests of the United States.

     SEC. 350. NAME OF DEPARTMENT OF VETERANS AFFAIRS MEDICAL 
                   CENTER, JOHNSON CITY, TENNESSEE.

       (a) Name.--The Mountain Home Department of Veterans Affairs 
     Medical Center in Johnson City, Tennessee, shall after the 
     date of the enactment of this Act be known and designated as 
     the ``James H. Quillen Department of Veterans Affairs Medical 
     Center''. Any reference to such medical center in any law, 
     regulation, map, document, record, or other paper of the 
     United States shall be considered to be a reference to the 
     James H. Quillen Department of Veterans Affairs Medical 
     Center.
       (b) Effective Date.--Subsection (a) shall take effect at 
     noon on January 3, 1997.

     SEC. 351. REPORT ON HEALTH CARE NEEDS OF VETERANS IN EAST 
                   CENTRAL FLORIDA.

       (a) Report Required.--Not later than 60 days after the date 
     of the enactment of this Act, the Secretary of Veterans 
     Affairs shall submit to the Committees on Veterans' Affairs 
     of the Senate and House of Representatives a report on the 
     health care needs of

[[Page S11742]]

     veterans in east central Florida. In preparing the report, 
     the Secretary shall consider the needs of such veterans for 
     psychiatric and long-term care. The Secretary shall include 
     in the report the Secretary's views, based on the Secretary's 
     determination of such needs, as to the best means of meeting 
     such needs using the amounts appropriated pursuant to the 
     authorization of appropriations in this Act and Public Law 
     103-452 for projects to meet the health care needs of such 
     veterans. The Secretary may, subject to the availability of 
     appropriations for such purpose, use an independent 
     contractor to assist in the determination of such health care 
     needs.
       (b) Limitation.--The Secretary may not obligate any funds, 
     other than for design work, for the conversion of the former 
     Orlando Naval Training Center Hospital in Orlando, Florida 
     (now under the jurisdiction of the Secretary of Veterans 
     Affairs), to a nursing home care unit until 45 days after the 
     date on which the report required by subsection (a) is 
     submitted.

     SEC. 352. EVALUATION OF HEALTH STATUS OF SPOUSES AND CHILDREN 
                   OF PERSIAN GULF WAR VETERANS.

       (a) Extension of Authority.--Subsection (b) of section 107 
     of the Persian Gulf War Veterans' Benefits Act (title I of 
     Public Law 103-446; 108 Stat. 4652; 38 U.S.C. 1117 note) is 
     amended by striking out ``September 30, 1996'' and inserting 
     in lieu thereof ``December 31, 1998''.
       (b) Ratification of Actions.--Any diagnostic testing and 
     medical examinations undertaken by the Secretary of Veterans 
     Affairs for the purpose of the study required by subsection 
     (a) of such section during the period beginning on October 1, 
     1996, and ending on the date of the enactment of this Act is 
     hereby ratified.

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